Is premolar extraction necessary? (Photos)

I treat TMJ and Sleep Apnea patients many made worse by "4 on the floor"  bicuspid amputations.  The DNA Applaivnce and Epigenetic orthopedics/ orthodontics can grow the space needed to avoid extractions.Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMOPast Chair, Alliance of TMD OrganizationsDiplomat,  Academy of Integrative Pain ManagementDiplomat, American Board of Dental Sleep MedicineRegent & Fellow, International College of CranioMandibular OrthopedicsBoard Eligible, American Academy of CranioFacial PainDental Section Editor, Sleep & Health Journal
Member, American Equilibration SocietyMember, Academy of Applied Myofunctional SciencesMember, Academy of Cosmetic Dentistry

In general premolar extractions can cause future problems as you have noted. In addition cosmetically the smile is not natural and the face profile is flattened rather than curved with premolar extraction. First and foremost is to have the arches expanded. Possibly with the 3rd molars extracted. With the ceph x-ray properly traced, the models measured then an accurate treatment plan can be developed.My suggestion is to get a second opinion and search for a dentist that practices functional or neuromuscular orthodontics. These practitioners are focused on your total body health not just straight teeth. Hope this helps.